1989, 09-14 Permit App: 89003377 Gas Log, PipingMECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: (p t / 7 ,, 5> iL
CITY/STATE/ZIP: s'/}-rH E PARCEL NUMBER:
OWNER: .GLE,/ 13,4 de/ 77- PHONE NUMBER: ?-941 -4W.2 9
MAILING ADDRESS! (a8/7 ., T1 4 -e- -9°4k»7,4r AI/} 992/2
(Street) (City/State) (Zip)
CONTRACTOR: BANNER FURNACE &, FUEL LICENSE NUMBER:
CONTACT: RUSS LUNDE
MAILING ADDRESS: P.O. BOX 4346
BANNEFF378NT
PHONE NUMBER: 535-1711
SPOKANE, WASHINGTON 99202
(Street)
(City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER X EACH
OF UNITS UNIT
= AMOUNT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100;000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIPING (5 OR MORE. EACH:)
REFRIG 1-100M BTU ('NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
HEAT PUMP & AIR CONDITIONER 15-30 TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS
VENTILATING FANS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU
USED APPLIANCE <400,000 BTtJ
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
1
X$10.00 =
X 25.00 =
x 10.00 =
X 12.00 =
X 15.00 =
x 4.00 =
x 1.00 =
X 12.00 =
x 20.00 =
X 25.00 =
X 35.00 =
x 60.00 =
X 12.00 =
X 20.00 =
x 25.00 =
X 35.00 =
X 60.00 =
X 10.00 =
x 10.00 =
X 50.00 =
X 10.00 =
x 10.00 =
X 10.00 =
X 10.00 =
X 10.00 =
x 50.00 =
x100.00 =
X 50.00 =
X100.00 =
x 12.00 =
X 15.00 =
4/.00
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE ,1. e en''GV(/it��.,�'b
West Spokane`3dway AvenuemSpokanel Buildingand(509) 456-3675
SUBTOTAL
PLUS: PROCESSING FEE + $ 25.00
$ /'/.00
EQUALS: TOTAL PERMIT
FEE DUE _ $ 3 7.00